What is Diabetic Neuropathy?

Diabetic neuropathy is a type of nerve damage caused by diabetes or poor blood sugar control. It can develop slowly after many years of diabetes or may occur early in the disease. (NIH.gov)

What Are the Different Types of Diabetic Neuropathy?

There are different types of diabetic neuropathy, depending on the type and number of nerves damaged. Types of diabetic neuropathy include the following:

Peripheral Neuropathy

Peripheral neuropathy is nerve damage that affects the feet and legs and can affect the hands and arms.

This is the most common form of neuropathy. It is estimated that up to 50 percent of diabetics will experience peripheral neuropathy. More than 20 million people in the U.S. are estimated to have some form of peripheral neuropathy.

Due to a lack of feeling in feet, foot ulcers account for 25 % of complications from peripheral neuropathy. If not treated properly, foot ulcers will progress to infections, resulting in amputation.

One of the more dangerous symptoms of peripheral neuropathy is the inability to feel hot or cold temperatures. This can result in frostbite or burns to the feet.

Autonomic Neuropathy

Autonomic neuropathy is damage to nerves that control your internal organs. Autonomic neuropathy can lead to problems with your heart rate and blood pressure, digestive system, bladder, sex organs, sweat glands, eyes, and ability to sense hypoglycemia.

Here's how it could affect the following organs:

Heart: Your ability to feel pain when your heart is not getting enough oxygen or when you're having a heart attack. Feeling light-headed when standing up or lying down.
Digestive System: You could experience constipation, diarrhea, fecal incontinence, and even difficulty swallowing.
Bladder: You may find it hard to control your bladder or even not be able to feel when you need to use the restroom, and this can cause damage, which can make you more prone to bladder infections.
Eyes: Damage to the nerves in your eyes can make them slow to respond to changes in light and dark. You may even have trouble driving at night.

Focal Neuropathies

Focal neuropathies usually occur slowly and over time, they can damage your nerves and small blood vessels that nourish your nerves. (NIH.gov)

Examples of focal neuropathies include:

Carpal Tunnel Syndrome, which is the most common neuropathy that affects diabetics. It is estimated that about 25 percent of people with diabetes have some sort of nerve compression at the wrist. Symptoms of carpal tunnel syndrome are numbness, tingling in the hands, middle finger and index finger weakness when gripping objects, and pain.
Ulnar Entrapment, which causes pain, numbness, and tingling in the little and ring finger
Pain in the front of the thigh
Pain in the shin or foot

Cranial Neuropathies

Cranial neuropathies are focal neuropathies that affect the nerves in the head, can also cause symptoms such as:

Blurred or double vision
Aching behind one eye
Problems focusing your eyes
Paralysis on one side of your face, called Bell’s palsy

Proximal Neuropathy

Proximal neuropathy is a rare and disabling type of nerve damage in your hip, buttock, or thigh. This type of nerve damage typically affects one side of your body and may rarely spread to the other side.

Symptoms include:

Weight loss
Loss of reflexes
Muscle wasting, or the loss of muscle tissue
Difficulty arising from a seated position

How is Diabetic Neuropathy Tested?

Physical examination identifies areas of numbness, weakness, tingling, or pain and patterns that may lead to a diagnosis of neuropathy. Nerve conduction tests can measure the speed of electrical signals traveling through the nerves and are a valuable tool in diagnosing the type of neuropathy. In addition, laboratory tests such as one for glucose levels are another blood sugar test that can identify diabetes and lead to further testing such as that stated above.

Risk Factors for Diabetic Neuropathy

Risk Factors for diabetic neuropathy include:

Poorly controlled blood sugar levels
Smoking
Age- while diabetic neuropathy can occur at any age, the longer you have diabetes, the more at risk you are for neuropathy.
Family history of diabetes
Alcohol consumption- alcohol increases blood glucose levels
Obesity
High triglyceride levels

Prevention

Preventing diabetic neuropathy starts with effective diabetes management. Here are some key steps to reduce your risk:

Manage Blood Sugar: High blood sugar damages nerves and small blood vessels. Keeping your blood sugar level within limits established by your doctor will help you prevent diabetic neuropathy.

Quit Smoking: Smoking lowers the oxygen level in your blood, leading to hypoxia and nerve damage.

Maintain a Healthy Diet: Lean proteins, fish, and high-fiber foods promote overall Wellness. They also help manage your weight and blood sugar.

Manage Stress: Managing your stress level with relaxation, meditation, and pleasurable activities can help reduce high cortisol levels associated with stress. High cortisol levels caused by stress lead to higher blood glucose levels, which, in turn, makes it difficult to manage adequate blood sugar control.

Exercise Regularly: Exercise has a wide variety of benefits. From lowering stress levels, increasing circulation to all parts of the body, moving lymphatic fluids, and managing blood glucose levels. According to the American Diabetic Association, aim for at least 150 minutes of walking-type exercise every week, divided into five days a week for 30-minute walks, will help with stress reduction, getting the lymphatic and blood fluids moving, and blood sugar control.

Treatments for Diabetic Neuropathy

In addition to the diet and lifestyle changes we mentioned earlier, physical therapy and medications often play an important role in managing the symptoms of diabetic neuropathy, particularly when it comes to pain management.

Antidepressants:
- Tricyclic Antidepressants (TCAs): Medications like Amitriptyline and Norpramin which alter the perception of pain signals in the brain.
- Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Medications such as Cymbalta and Effexor which can help manage pain by increasing the levels of certain neurotransmitters in the brain.
Anticonvulsants:
- Medications like Neurontin and Lyrica are used to control seizures but are also effective in managing neuropathic pain.
Over-the-Counter Pain Relievers:

Some over-the-counter medications, such as Tylenol or Advil, can help control symptoms.
Topical Medications:

Capsaicin and Lidocaine patches can also help relieve pain.
Physical Therapy:

Physical therapy can help reduce pain from peripheral neuropathy. (e.g., weight training, and stretching, Tai Chi, etc.)

Prognosis

Prognosis depends on how well blood sugar is controlled, lifestyle choices such as smoking cessation, regular exercise, stress reduction, and overall physical health.

Research

There is ongoing research on whole nerve metabolism, the nutrients involved, and how energy is shared between cells. Research into the role of insulin and insulin resistance in the peripheral nervous system is also being conducted. Additional testing of metabolic functions that regulate mitochondrial function continues.

Summary

Diabetic Neuropathy in diabetics or those with poor blood sugar control can lead to a multitude of symptoms and issues. However, lifestyle changes and medication can help your loved one manage manage these symptoms and lead to a better quality of life.